Hematuria Flashcards
1
Q
What is GROSS hematuria?
A
- VISIBLE blood in the urine
- urological cancer is found 23% of the time.
- no etiology is found only 8% of the time.
2
Q
** What is MICROSCOPIC hematuria? (TEST QUESTION)
A
- greater than 3 RBC/hpf in a single specimen.
* 43% of the time there is no evident cause.
3
Q
** How the body help to treat a large bladder clot? (TEST QUESTION)
A
- urokinase= converts plasminogen to plasmin, leading to clot lysis.
4
Q
What are some drugs that can cause red urine?
A
- RIFAMPIN
- phenazopyridine
- sulfamethoxazole (Bactrim)
- Nitrofurantoin
- Ibuprofen
- Phenytoin
- Methyldopa
- Chloroquine
- Phenacetin
- Levodopa
- Quinine
5
Q
How sensitive and specific is a urine dip stick?
A
- 95% sensitive
- 75% specific
- MUST GET MICROSCOPIC URINALYSIS if you get a positive result on dip stick screening test.
6
Q
What is a microscopic urinalysis?
A
- clean catch or catheterized urine is centrifuged and then examined under hpf.
7
Q
What microscopic urinalysis results would point you toward a nephrologic cause?
A
- 2+ protein (proteinuria), dysmorphic RBCs, or RBC casts
8
Q
What are the 3 general causes of hematuria?
A
- glomerular (nephrology)
- nonglomerular (upper or lower tract)
- pseudohematuria
9
Q
What is your DDx for hematuria?
A
- period (pseudohematuria)
- prostatitis, prostate cancer, BPH
- obstructive uropathy (nephrolithiasis or ureteral tumors).
- nephritis (glomerulonephritis, interstitial nephritis…)
- trauma of GU system
- tumors of the GU system (bladder, renal, ureteral, prostatic).
- hematologic (anticoagulation, bleeding disorders, sickle cell)
- infection/inflammation (cystitis, pyelonephritis, chronic foley, TB)
- stones
- previous irradiation or chemo
- arteriovenous fistula
- beet consumption
- occupational exposure
10
Q
How do you evaluate hematuria?
A
- thorough H&P
11
Q
How should you carry out a diagnostic eval of hematuria?
A
- microscopic urinalysis
- urine culture
- urine cytology
- cystoscopy
- imaging
12
Q
What is urine cytology?
A
- microscopic examination of exfoliated urothelial cells obtained by voided urine or bladder washings.
- cells are less cohesive in poorly differentiated tumors, therefore, cytology will be more likely to detect the tumor.
13
Q
Should you always do urine cytology?
A
- ALWAYS for GROSS hematuria, but optional for microscopic hematuria.
14
Q
Should you always do cystoscopy?
A
- ALWAYS for GROSS hematuria, but optional in patients less than 35 y/o with microscopic hematuria.
15
Q
What is the gold standard imaging eval?
A
- CT urogram= CT of the abdomen and pelvis with 3 phases (noncontrast, nephrogenic, and excretory).
